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Open Access 04-01-2025 | Eating Disorder | Article

Eating disorders among people with and without type 1 diabetes: incidence and treatment in a nationwide population-based cohort

Authors: Leon Hirvelä, Jari Haukka, Anna Keski-Rahkonen, Pyry N. Sipilä

Abstract

Aims/hypothesis

Eating disorders are over-represented in type 1 diabetes and are associated with an increased risk of complications, but it is unclear whether type 1 diabetes affects the treatment of eating disorders. We assessed incidence and treatment of eating disorders in a nationwide sample of individuals with type 1 diabetes and diabetes-free control individuals.

Methods

Our study comprised 11,055 individuals aged <30 who had been diagnosed with type 1 diabetes in 1998–2010, and 11,055 diabetes-free control individuals matched for age, sex and hospital district. We ascertained incidence of eating disorders from hospital records using Poisson regression. Eating disorder treatment was assessed by new prescriptions for psychotropic medications and hospital treatment for eating disorders.

Results

During a mean follow-up of 13.1 years, there were 175 incident cases of eating disorders among individuals with type 1 diabetes and 75 among the control individuals (adjusted incidence rate ratio 2.35; 95% CI 1.80, 3.09). The prescription of psychotropic medications was similar among eating disorder patients with and without type 1 diabetes. However, those with type 1 diabetes received outpatient hospital treatment for their eating disorder less often than those without diabetes (mean 3.32 vs 5.33 outpatient care visits per year [adjusted difference 1.24; 95% CI 0.39, 2.08]).

Conclusions/interpretation

People with type 1 diabetes are more likely to be diagnosed with eating disorders than their diabetes-free peers. However, they receive less outpatient hospital treatment for their eating disorders despite their greater risk for major adverse health outcomes. These findings emphasise the need for targeted eating disorder treatment for people with type 1 diabetes.

Graphical Abstract

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Silén Y, Sipilä PN, Raevuori A et al (2020) DSM-5 eating disorders among adolescents and young adults in Finland: a public health concern. Int J Eat Disord 53(5):520–531. https://doi.org/10.1002/eat.23236CrossRefPubMed

Silén Y, Keski-Rahkonen A (2022) Worldwide prevalence of DSM-5 eating disorders among young people. Curr Opin Psychiatry 35(6):362–371. https://doi.org/10.1097/YCO.0000000000000818CrossRefPubMed

Dybdal D, Tolstrup JS, Sildorf SM et al (2018) Increasing risk of psychiatric morbidity after childhood onset type 1 diabetes: a population-based cohort study. Diabetologia 61(4):831–838. https://doi.org/10.1007/s00125-017-4517-7CrossRefPubMed

Cooper MN, Lin A, Alvares GA, de Klerk NH, Jones TW, Davis EA (2017) Psychiatric disorders during early adulthood in those with childhood onset type 1 diabetes: rates and clinical risk factors from population-based follow-up. Pediatr Diabetes 18(7):599–606. https://doi.org/10.1111/pedi.12469CrossRefPubMed

Jones JM, Lawson ML, Daneman D, Olmsted MP, Rodin G (2000) Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study. BMJ 320(7249):1563–1566CrossRefPubMedPubMedCentral

Colton PA, Olmsted MP, Daneman D, Rydall AC, Rodin GM (2007) Natural history and predictors of disturbed eating behaviour in girls with Type 1 diabetes. Diabet Med 24(4):424–429. https://doi.org/10.1111/j.1464-5491.2007.02099.xCrossRefPubMed

Olmsted MP, Colton PA, Daneman D, Rydall AC, Rodin GM (2008) Prediction of the onset of disturbed eating behavior in adolescent girls with type 1 diabetes. Diabetes Care 31(10):1978–1982. https://doi.org/10.2337/dc08-0333CrossRefPubMedPubMedCentral

Wisting L, Siegwarth C, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø (2020) The impact of psychological aspects, age, and BMI on eating disorder psychopathology among adult males and females with type 1 diabetes. Health Psychol Open 7(2):2055102920975969. https://doi.org/10.1177/2055102920975969CrossRefPubMedPubMedCentral

Wisting L, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø (2018) Prevalence of disturbed eating behavior and associated symptoms of anxiety and depression among adult males and females with type 1 diabetes. J Eat Disord 6:28. https://doi.org/10.1186/s40337-018-0209-zCrossRefPubMedPubMedCentral

10.

Wisting L, Bang L, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø (2015) Adolescents with type 1 diabetes-the impact of gender, age, and health-related functioning on eating disorder psychopathology. PLoS One 10(11):e0141386. https://doi.org/10.1371/journal.pone.0141386CrossRefPubMedPubMedCentral

11.

Winston AP (2020) Eating disorders and diabetes. Curr Diab Rep 20(8):32. https://doi.org/10.1007/s11892-020-01320-0CrossRefPubMed

12.

Takii M, Uchigata Y, Tokunaga S et al (2008) The duration of severe insulin omission is the factor most closely associated with the microvascular complications of type 1 diabetic females with clinical eating disorders. Int J Eat Disord 41(3):259–264. https://doi.org/10.1002/eat.20498CrossRefPubMed

13.

Goebel-Fabbri AE, Fikkan J, Franko DL, Pearson K, Anderson BJ, Weinger K (2008) Insulin restriction and associated morbidity and mortality in women with type 1 diabetes. Diabetes Care 31(3):415–419. https://doi.org/10.2337/dc07-2026CrossRefPubMed

14.

Steel JM, Young RJ, Lloyd GG, Clarke BF (1987) Clinically apparent eating disorders in young diabetic women: associations with painful neuropathy and other complications. Br Med J (Clin Res Ed) 294(6576):859–862. https://doi.org/10.1136/bmj.294.6576.859CrossRefPubMed

15.

Scheuing N, Bartus B, Berger G et al (2014) Clinical characteristics and outcome of 467 patients with a clinically recognized eating disorder identified among 52,215 patients with type 1 diabetes: a multicenter german/austrian study. Diabetes Care 37(6):1581–1589. https://doi.org/10.2337/dc13-2156CrossRefPubMed

16.

Rydall AC, Rodin GM, Olmsted MP, Devenyi RG, Daneman D (1997) Disordered eating behavior and microvascular complications in young women with insulin-dependent diabetes mellitus. N Engl J Med 336(26):1849–1854. https://doi.org/10.1056/NEJM199706263362601CrossRefPubMed

17.

Gibbings NK, Kurdyak PA, Colton PA, Shah BR (2021) Diabetic ketoacidosis and mortality in people with type 1 diabetes and eating disorders. Diabetes Care 44(8):1783–1787. https://doi.org/10.2337/dc21-0517CrossRefPubMed

18.

Nielsen S, Emborg C, Mølbak A-G (2002) Mortality in concurrent type 1 diabetes and anorexia nervosa. Diabetes Care 25(2):309–312. https://doi.org/10.2337/diacare.25.2.309CrossRefPubMed

19.

Crone C, Fochtmann LJ, Attia E et al (2023) The American psychiatric association practice guideline for the treatment of patients with eating disorders. AJP 180(2):167–171. https://doi.org/10.1176/appi.ajp.23180001CrossRef

20.

Hilbert A, Hoek HW, Schmidt R (2017) Evidence-based clinical guidelines for eating disorders: international comparison. Curr Opin Psychiatry 30(6):423–437. https://doi.org/10.1097/YCO.0000000000000360CrossRefPubMedPubMedCentral

21.

Pruccoli J, Bergonzini L, La Tempa A, Parmeggiani A (2022) Antipsychotics in the treatment of children and adolescents with anorexia nervosa: a systematic review. Biomedicines 10(12):3167. https://doi.org/10.3390/biomedicines10123167CrossRefPubMedPubMedCentral

22.

Couturier J, Isserlin L, Spettigue W, Norris M (2019) Psychotropic medication for children and adolescents with eating disorders. Child Adolesc Psychiatr Clin N Am 28(4):583–592. https://doi.org/10.1016/j.chc.2019.05.005CrossRefPubMed

23.

Radojčić MR, Pierce M, Hope H et al (2023) Trends in antipsychotic prescribing to children and adolescents in England: cohort study using 2000–19 primary care data. Lancet Psychiatry 10(2):119–128. https://doi.org/10.1016/S2215-0366(22)00404-7CrossRefPubMed

24.

Clery P, Stahl D, Ismail K, Treasure J, Kan C (2017) Systematic review and meta-analysis of the efficacy of interventions for people with type 1 diabetes mellitus and disordered eating. Diabet Med 34(12):1667–1675. https://doi.org/10.1111/dme.13509CrossRefPubMed

25.

Colton PA, Olmsted MP, Wong H, Rodin GM (2015) Eating disorders in individuals with type 1 diabetes: case series and day hospital treatment outcome. Eur Eat Disord Rev 23(4):312–317. https://doi.org/10.1002/erv.2365CrossRefPubMed

26.

Custal N, Arcelus J, Agüera Z et al (2014) Treatment outcome of patients with comorbid type 1 diabetes and eating disorders. BMC Psychiatry 14:140. https://doi.org/10.1186/1471-244X-14-140CrossRefPubMedPubMedCentral

27.

Alloway SC, Toth EL, McCargar LJ (2001) Effectiveness of a group psychoeducation program for the treatment of subclinical disordered eating in women with type 1 diabetes. Can J Diet Pract Res 62(4):188–192PubMed

28.

Takii M, Uchigata Y, Komaki G et al (2003) An integrated inpatient therapy for type 1 diabetic females with bulimia nervosa: a 3-year follow-up study. J Psychosom Res 55(4):349–356. https://doi.org/10.1016/s0022-3999(02)00629-3CrossRefPubMed

29.

Takii M, Uchigata Y, Komaki G et al (2002) A cognitive/behavioral approach to type 1 diabetic females with recurrent binge eating: a 3-year follow-up study. Int Congress Ser 1241:291–296. https://doi.org/10.1016/S0531-5131(02)00614-3CrossRef

30.

Olmsted MP, Daneman D, Rydall AC, Lawson ML, Rodin G (2002) The effects of psychoeducation on disturbed eating attitudes and behavior in young women with type 1 diabetes mellitus. Int J Eat Disord 32(2):230–239. https://doi.org/10.1002/eat.10068CrossRefPubMed

31.

Wagner G, Karwautz A (2020) Eating disorders in adolescents with type 1 diabetes mellitus. Curr Opin Psychiatry 33(6):602–610. https://doi.org/10.1097/YCO.0000000000000650CrossRefPubMed

32.

Liu S, Lagerberg T, Ludvigsson JF et al (2023) Psychotropic medication use in children and adolescents with type 1 diabetes. JAMA Netw Open 6(10):e2336621. https://doi.org/10.1001/jamanetworkopen.2023.36621CrossRefPubMedPubMedCentral

33.

Newcomer JW (2005) Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review. CNS Drugs 19(Suppl 1):1–93. https://doi.org/10.2165/00023210-200519001-00001CrossRefPubMed

34.

Knip M (2021) Type 1 diabetes in Finland: past, present, and future. Lancet Diabetes Endocrinol 9(5):259–260. https://doi.org/10.1016/S2213-8587(21)00074-7CrossRefPubMed

35.

Niskanen L, Partonen T, Auvinen A, Haukka J (2020) Trends and predictors in all-cause and cause-specific mortality in diabetic and reference populations during 21 years of follow-up. J Epidemiol Community Health 74(11):950–956. https://doi.org/10.1136/jech-2019-213602CrossRefPubMed

36.

Finland - Kansaneläkelaitos, Kela (The Social Insurance Institution). Available from: https://socialprotection.org/connect/stakeholders/finland-kansanel%C3%A4kelaitos-kela-social-insurance-institution (accessed 8 Oct 2024)

37.

Lammi N, Taskinen O, Moltchanova E et al (2007) A high incidence of type 1 diabetes and an alarming increase in the incidence of type 2 diabetes among young adults in Finland between 1992 and 1996. Diabetologia 50(7):1393–1400. https://doi.org/10.1007/s00125-007-0690-4CrossRefPubMed

38.

Rawshani A, Landin-Olsson M, Svensson A-M et al (2014) The incidence of diabetes among 0–34 year olds in Sweden: new data and better methods. Diabetologia 57(7):1375–1381. https://doi.org/10.1007/s00125-014-3225-9CrossRefPubMedPubMedCentral

39.

Care Register for Health Care - THL. In: Finnish Institute for Health and Welfare (THL), Finland. Available from: https://thl.fi/en/statistics-and-data/data-and-services/register-descriptions/care-register-for-health-care (accessed 8 Oct 2024)

40.

Statistics Finland (1989) Classification of Socio-economic Groups 1989. Available from: https://stat.fi/en/luokitukset/sosioekon_asema/sosioekon_asema_1_19890101. (accessed 8 Oct 2024)

41.

Macdonald P, Kan C, Stadler M et al (2018) Eating disorders in people with type 1 diabetes: experiential perspectives of both clients and healthcare professionals. Diabet Med 35(2):223–231. https://doi.org/10.1111/dme.13555CrossRefPubMed

42.

Galler A, Bollow E, Meusers M et al (2015) Comparison of glycemic and metabolic control in youth with type 1 diabetes with and without antipsychotic medication: analysis from the nationwide German/Austrian Diabetes Survey (DPV). Diabetes Care 38(6):1051–1057. https://doi.org/10.2337/dc14-2538CrossRefPubMed

43.

Silén Y, Sipilä PN, Raevuori A et al (2021) Detection, treatment, and course of eating disorders in Finland: a population-based study of adolescent and young adult females and males. Eur Eat Disord Rev 29(5):720–732. https://doi.org/10.1002/erv.2838CrossRefPubMedPubMedCentral

44.

Isomaa R, Isomaa A-L, Marttunen M, Kaltiala-Heino R, Björkqvist K (2009) The prevalence, incidence and development of eating disorders in Finnish adolescents: a two-step 3-year follow-up study. Eur Eat Disord Rev 17(3):199–207. https://doi.org/10.1002/erv.919CrossRefPubMed

45.

Solmi M, Radua J, Olivola M et al (2022) Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry 27(1):281–295. https://doi.org/10.1038/s41380-021-01161-7CrossRefPubMed

Title: Eating disorders among people with and without type 1 diabetes: incidence and treatment in a nationwide population-based cohort
Authors: Leon Hirvelä
Jari Haukka
Anna Keski-Rahkonen
Pyry N. Sipilä
Publication date: 04-01-2025
Publisher: Springer Berlin Heidelberg
Keywords: Eating Disorder
Eating Disorder
Eating Disorder
Type 1 Diabetes
Published in: Diabetologia
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-024-06346-7

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